Comparative Effectiveness Review of Antimicrobial Central Line Dressings for the Prevention of Central Line-Associated Bloodstream Infections

Health Problem: Intravenous catheters provide essential venous access when treating patients who are acutely or chronically ill, but their use also increases the risk of complications such as central line-associated bloodstream infections (CLABSIs). CLABSIs occur when microorganisms gain access to the bloodstream via 1 of several different routes: catheter hub contamination, catheter insertion-site colonization, contaminated infusate, and/or hematogenous seeding. Patients who develop a CLABSI have poorer health outcomes costing billions of dollars in added healthcare costs in the U.S. annually and contributing to thousands of patient deaths.

Technology Description: Central venous catheters (CVCs) are implantable synthetic catheters used to access a central vein, infuse solutions, take blood samples, measure central venous temperatures, and monitor central venous pressures. In an attempt to reduce the incidence of potentially harmful CVC colonization and infection, several antimicrobial agents (chlorhexidine gluconate [CHG], silver alginate, and polyhexamethylene biguanide), have been incorporated into CVC dressings by multiple manufacturers. Dressings are placed at the CVC insertion site to provide a barrier between the skin and the surrounding environment.

Controversy: Because antimicrobial central line dressings are used in conjunction with several other methods of reducing CLABSI, including maximum sterile barrier insertion techniques, the impact these dressings will have on further reducing CLABSI is uncertain. Antimicrobial dressings containing CHG have been associated with a reduction in the rate of catheter-related bloodstream infections (CRBSIs) and catheter colonization. However, their effect on the rate of CLABSI compared with non-CHG dressings is less clear.